Predicting outcomes and management of candidates for heart transplantation.
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Adolescent↗
Biomedical subjects
N Hirata
Publications and source records attributed to N Hirata.
Expression and localization of histamine H2 receptor messenger RNA in human nasal mucosa.
BACKGROUND: Histamine is an important chemical mediator in allergic rhinitis. Histamine H2 receptor (H2R) stimulation controls histamine release and mediates mucus secretion, suggesting that H2R might play some role in allergic rhinitis. OBJECTIVE: The objective of this study was to examine whether H2R mRNA expression is increased in patients with allergic rhinitis compared with normal subjects and to determine the localization of H2R mRNA in the human nasal mucosa. METHODS: We extracted RNA from scrapings of the inferior turbinate mucosa of 11 patients with allergic rhinitis. H2R and beta-actin mRNA were amplified by RT-PCR. In situ hybridization with a digoxigenin-labeled H2R cRNA probe was performed on surgical specimens of nasal turbinate of patients with allergic rhinitis. RESULTS: The mean +/- SD of H2R/beta-actin ratios were 0.12 +/- 0.16 for the scrapings of normal subjects and 0.35 +/- 0.20 for the scrapings of patients with allergic rhinitis; the difference was statistically significant (P <.01). H2R mRNA was localized in the epithelium, serous cells, and mucous cells. CONCLUSION: These data suggest that H2R mRNA is localized in the epithelium and the submucosal glands and that increased H2R may be playing some role in patients with allergic rhinitis.
Actins↗
Real time assessment of myocardial revascularization during coronary artery bypass surgery by means of ultrasonic integrated backscatter.
OBJECTIVE: The recovery of cyclic variation (CV) of ultrasonic integrated backscatter (IB) may provide a more sensitive predictor of the success of myocardial revascularization. This study was designed to elucidate the possibility of real time assessment of coronary artery bypass grafting (CABG) using CV of IB. METHODS: We studied 10 patients (61 +/- 4 years old) with the perfused areas by stenosed or occluded LAD without myocardial infarction. There were six ischemic dysfunctional areas, and four ischemic but non-dysfunctional areas. The CV of IB was measured before and just after extracorporeal circulation (ECC). Wall motion was analyzed by segmental wall thickening during systole at the same time of the IB analysis during CABG and at 3 weeks after CABG. Those 10 areas were completely revascularized. RESULTS: In the non-dysfunctional areas, wall thickening did not change and remained at normal values before and after ECC, and 3 weeks after CABG (31 +/- 3% 29 +/- 3% and 29 +/- 5%, respectively). The magnitude of CV of IB did not also change before and after ECC (8.0 +/- 1.6 dB and 7.8 +/- 1.3 dB). However, in the ischemic dysfunctional areas, while wall thickening did not change before and after ECC (21 +/- 5% and 20 +/- 5%), it increased and reached similar values as the non-dysfunctional regions at 3 weeks after CABG (26 +/- 7%, P < 0.01 vs. before and after ECC values). The magnitude of CV of IB increased even after ECC (3.71 +/- 0.4 dB vs. 7.4 +/- 3.5 dB, P < 0.05), and reached the same level as those in the non-dysfunctional areas. There was a significant relationship between wall thickening at 3 weeks after bypass grafting and magnitude of CV of IB after ECC (r = 0.67, P < 0.05). CONCLUSIONS: Improvement in wall motion was gradually attained after bypass grafting. On the contrary, an increase in the magnitude of CV of IB was obtained immediately after myocardial revascularization. Our data suggest that CV of ultrasonic IB method can provide close real time information regarding the effectiveness of bypass surgery.
Coronary Artery Bypass↗
Expression of histidine decarboxylase messenger RNA and histamine N-methyltransferase messenger RNA in nasal allergy.
BACKGROUND: Histamine is an important chemical mediator in allergic rhinitis. Histamine is synthesized by L-histidine, catalysed by L-histidine decarboxylase (HDC) and metabolized mainly by histamine N-methyltransferase (HMT). The patients with allergic rhinitis may have altered histamine metabolism in the nasal tissue. OBJECTIVE: The objective was to compare the expression of HDC mRNA and HMT mRNA in nasal mucosa with normal individuals and patients with allergic rhinitis. METHODS: We extracted RNA from scrapings of inferior turbinate mucosa of 11 patients with allergic rhinitis and from 11 normal subjects and from surgically dissected inferior turbinate mucosa of 11 patients. HDC, HMT and beta-actin mRNA were amplified by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: The mean +/- SD of HDC/beta-actin ratios were 0.58 +/- 0.28 for the scrapings of normal subjects, 0.93 +/- 0.38 for the scrapings of the patients with allergic rhinitis and 1.41 +/- 0.26 for the inferior turbinates of the patients with allergic rhinitis. The mean +/- SD of HMT/beta-actin ratios were 1.66 +/- 0.27 for the scrapings of normal subjects, 0.93 +/- 0.20 for the scrapings of the patients with allergic rhinitis and 0.65 +/- 0.28 for the inferior turbinates of the patients with allergic rhinitis. The differences among the three groups were statistically significant. CONCLUSIONS: Increased HDC mRNA expression and decreased HMT mRNA expression may be playing some role in the hyperresponsiveness of patients with allergic rhinitis.
Actins↗
The role of cysteinyl leukotrienes in the pathogenesis of asthma: clinical study of leukotriene antagonist pranlukast for 1 year in moderate and severe asthma.
Clinical studies have shown that pranlukast (Ono Pharmaceutical Co., Osaka, Japan) is effective for mild and moderate asthma. However, it is not well known that pranlukast is also effective on moderate and severe persistent asthma in the long term. We studied the effect of pranlukast on moderate and severe asthmatics by evaluating the change of peak expiratory flow (PEF) and therapeutic scores for 1 year before and during pranlukast therapy. We gave pranlukast 225 mg twice daily orally to 25 patients who were receiving more than 400 micrograms/day beclomethasone inhalation and beta 2 stimulant inhalation with or without oral corticosteroid. Pranlukast increased PEF more than 10 L/min in 14 patients in the first 4 weeks. In these 14 patients, 10 patients continued to monitor PEF and kept asthma diaries for 1 year. We compared the data for 1 year before and during the pranlukast therapy. During the pranlukast therapy, PEF significantly increased, puffs of beta 2 stimulant inhalation significantly decreased. The incidence of oral corticosteroid rescue therapy reduced, and the mean daily dose of oral corticosteroid decreased; however, they were not statistically significant. During treatment with pranlukast, no side effect was observed. From these results, we suggest that pranlukast is effective for more than half of the moderate and severe persistent asthmatics, and that the effectiveness continues for more than 1 year.
Adult↗
Action of a new mammalian DNA polymerase inhibitor, sulfoquinovosyldiacylglycerol.
We found and previously reported a new mammalian DNA polymerase inhibitor from a sea alga, Gigartina tenella, (Ohta K., et al., Chem. Pharm. Bull., 46, 684-686, 1998). It was a new sulfolipid compound that belonged in the class of sulfoquinovosyldiacylglycerol. The biochemical properties have been investigated here. The compound, temporarily designated KM043, potently inhibited the activities of mammalian DNA polymerase alpha(pol. alpha) and DNA polymerase beta(pol. beta) and terminal deoxynucleotidyl transferase (TdT), and moderately, human immunodeficiency virus reverse transcriptase (HIV-RT). KM043 dose-dependently inhibited their activities, and each of their IC50 values was 0.25 microM for pol. alpha, 0.38 microM for TdT, 3.6 microM for pol. beta, or 11.2 microM for HIV-RT, and almost complete inhibition of each was achieved at 1.0 to 2.0 microM for pol. alpha and TdT, 7.5 microM for pol. beta and about 30 microM for HIV-RT. However, the compound did not influence the activities of prokaryotic DNA polymerases such as E. coli DNA polymerase I, and DNA metabolic enzymes like DNase 1. Inhibition of pol. alpha or beta by KM043 was non-competitive with both the DNA template and the substrate deoxythymidine 5'-triphosphate (dTTP). KM043 was weakly cytotoxic to cultured HeLa-S3 cells, and the IC50 value was 80 microM. KM043 could synergistically enhance the cytocidal effect of an anti-cancer chemotherapy agent, bleomycin. In the presence of 50 microM KM043, the effect ratio of (bleomycin plus KM043)/(bleomysin only) decreased from 0.76 to 0.22.
Animals↗
[Effect of transurethral collagen injection for vesicoureteral reflux in patients with spina bifida].
BACKGROUND: The effect of endoscopic injection of collagen was assessed in spina bifida patients with vesicoureteral reflux (VUR). METHODS: Endoscopic collagen injection was carried out for grade II or worse VUR according to the international classification. Twenty-two ureters were studied in 6 boys and 8 girls (mean: 14.4 years) who were followed up over a period of at least 3 months (mean: 5 months) after surgery they all had a negative preoperative skin test for collagen and were investigated radiologically and urodynamically. Cystograpy was performed 1, 3 and 12 months after surgery and thereafter once a year to detect recurrence of VUR. RESULTS: Anesthesia was not necessary in 4 patients. No adverse reactions occurred to the injection of collagen. VUR disappeared after 1 and 2 collagen injections in 17 (77%) and 2 (9%) ureters, respectively. The therapeutic effect of the single collagen injection showed no relationship to shape of the ureteral orifice, grade of VUR, compliance of the bladder, and presence of detrusor hyperreflexia. CONCLUSIONS: Endoscopic treatment of VUR with collagen injection in spina bifida patients is a simple and less invasive method. We obtained satisfactory short-term results by this method. However, since the risk factor of recurrence remains unclear, sufficient investigation of long-term results is important to determine the role of this method in the treatment of VUR in patients with spina bifida.
Administration, Intravesical↗
[A case of acquired hemophilia A discovered by right renal bleeding].
An 81-year-old man was referred to our hospital with a chief complaint of asymptomatic macrohematuria. Cystoscopy revealed bleeding from the right ureteral orifice. Various examinations, including ureteroscopy, failed to find any abnormalities. As gingival bleeding followed the macrochematuria, further examinations of blood coagulatory function were undertaken. Decreased factor VIII coagulant activity accompanied by the presence of factor VIII inhibitor was revealed, leading to a final diagnosis of acquired hemophilia A. Macrohematuria and gingival bleeding immediately disappeared with oral administration of prednisolone at 30 mg per day, and the titer of factor VIII inhibitor decreased to an undetectable level by the 45th day of treatment. We emphasized the importance of blood coagulation testing in the examination of patients with macrohematuria.
Aged↗
[A case of multiple liver metastases showing good response by administration of carmofur alone in an aged patient with colorectal cancer].
An 85-year-old woman had an elevated serum tumor marker CEA, and CT examination revealed multiple liver metastases. The patient was treated with oral administration of 200 mg/day of carmofur (HCFU) alone in our hospital. As a result, more than 60% of the focuses of liver metastasis disappeared, and the level of CEA decreased. The present case seems to show that liver metastases were significantly decreased by chemotherapy with oral administration of HCFU by itself. Thus, the case suggests that HCFU is useful for the treatment of liver metastases from colorectal cancer.
Adenocarcinoma↗
[Dynamic MRI of intraductal papilloma].
MRI findings were retrospectively investigated in five cases of papilloma of the breast. The tumors, which had a smooth margin, were 8-28 mm in size and round(3), oval(1), and irregular(1)in shape. All tumors were well enhanced with Gd-DTPA: four were enhanced homogeneously and one inhomogeneously. Dynamic study demonstrated two different time-intensity curves: 1) an early enhancement pattern and 2) a slower enhancement pattern. Three tumors showed the early enhancement pattern, which is well known to be characteristic of malignancy, while the other two showed the slower enhancement pattern. In the latter cases, the intensity could not be measured accurately because the tumors were too small to set the ROI exactly within them. In conclusion, three of five papillomas demonstrated the early enhancement pattern on dynamic study, which means that the time-intensity curve cannot distinguish papilloma from carcinoma. Therefore, morphological features should also be taken into consideration in making the diagnosis.
Adult↗
[Evaluation of cerebral circulation during cardiopulmonary bypass using near-infrared spectroscopy].
Cerebral oxygenation level during cardiopulmonary bypass (CPB) was measured using near-infrared spectroscopy as a monitor of cerebral circulation in 30 patients. Six adult cases with thoracic aortic aneurysm were operated on using selective cerebral perfusion (SCP). CPB was established under moderate hypothermic temperature in 9 adult cases (hypothermic group, lowest blood temperature during CPB; 25 degrees C) and under normothermic temperature in 9 adult cases (normothermic group, lowest blood temperature during CPB; 34 degrees C). In congenital cases (n = 6), CPB was established under moderate hypothermic temperature (congenital group, lowest blood temperature; 25 degrees C). The oxyhemoglobin (HbO2) level showed a significant positive correlation with cerebral blood flow during SCP (r = 0.715). There was no significant correlation between SjO2 and HbO2 in the SCP group. The HbO2 levels in the hypothermic group after 30 and 60 min, from the initiation of CPB and 30 min. before the weaning of CPB were significant lower than the control level (p < 0.05). HbO2 levels in the congenital group after 0, 30 and 60 min. from the initiation of CPB and 30 min. before the weaning of CPB were significantly lower than the control level (p < 0.01). The deoxyhemoglobin (HbR) level in the hypothermic group after 30 and 60 from the initiation of CPB and 30 min. before the wearing of CPB were significantly higher than the pre level (p < 0.05). The mixed venous saturation (SvO2) in the normothermic group showed significant lower levels than those in the hypothermic group (p < 0.01). However, there was no significant difference in HbO2 levels between the two groups. In conclusion, these results suggest that near-infrared spectroscopy may be a noninvasive and useful technique for the cerebral circulation monitoring during CPB.
Adolescent↗
[Painless aortic dissection late after aortic valve replacement, presenting as superior vena cava syndrome].
A 68-year-old man, who had underwent aortic valve replacement (AVR) with Björk-Shiley disc valve for aortic regurgitation 17 years ago, was transferred to our hospital complaining of facial redness and swelling, without chest or back pain. Preoperative examination revealed DeBakey type II aortic dissection, which caused superior vena cava syndrome (SVC syndrome). Emergent ascending aortic replacement was performed, postoperatively central venous pressure (CVP) decreased from 33 to 9 mmHg, and SVC syndrome was relieved. Painless aortic dissection after AVR, presenting as SVC syndrome, is a rare case, and close follow-up should be performed under consideration of painless aortic dissection late after AVR.
Aged↗
Simultaneous operation for minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair.
Simultaneous minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair were conducted in a 66-year-old man uneventful, requiring no transfusion. Surgery required 9 hours and 2 minutes. The tracheal tube was extubated in the operating room. Postoperative bleeding was 215 ml. The postoperative course was very smooth, with the patient able to walk on postoperative day 1. Postoperative coronary arteriogram and aortogram showed favorable results and the patient was discharged on day 23 after surgery.
Aged↗
Endoscopic sphincterotomy and laparoscopic cholecystectomy in an infant with cholecysto-choledocholithiasis.
Laparoscopic cholecystectomy (LC) and endoscopic sphincterotomy (EST) are widely accepted procedures for cholecysto-choledocholithiasis in adults. However, their use in infants has not been reported. An 8-month-old girl presented with high fever and obstructive jaundice. Ultrasound scan showed acute cholecystitis with stones in the bile duct. After 2-week-long antibiotic therapy the acute cholecystitis and hepatic impairment resolved. An endoscopic retrograde cholangiopancreatography (ERCP) confirmed choledocholithiasis and cholecystolithiasis. Risk factors for the development of biliary calculi were not detected. One month after the restoration of her liver function, she underwent EST using a side-viewing endoscope with a small sphincterotome. A common bile duct stone was extracted using a basket catheter. LC was then carried out. The time interval between the EST and LC was 34 days. No complications have been noted for 6 months.
Cholangiopancreatography, Endoscopic Retrograde↗
Cardiac surgery in renal transplant recipients.
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Aortic Valve Insufficiency↗
Microbial contamination of 'sterile water' used in Japanese hospitals.
We examined the following samples of water from 10 hospitals for microbial contamination: water obtained using an ultra filtration system (UF water), a reverse osmosis system (RO water), a water distillation system (distilled water) and tap water. UF water and RO water are used for handwashing before surgery, and distilled water for the preparation of drugs. All 10 samples of tap water examined were contaminated with < 10 colony forming units (cfu)/mL. Thirteen (68%) of 19 samples of UF water, nine (53%) of 17 samples of RO water and 15 (79%) of 19 samples of distilled water were contaminated with 10(1)-10(4) cfu/mL. The majority of micro-organisms were non-fermentative bacteria such as Sphingomonas paucimobilis and CDC gr. IV C-2. Japanese hospitals commonly use UF water and RO water for preoperative handwashing under the assumption that it is sterile. Our results suggest, however, that these types of water are inferior microbiologically to tap water. Distilled water from the dispensary was also contaminated with micro-organisms. The available chlorine content of tap water was 0.17-0.42 ppm and that of UF water (from tap water) 0-0.06 ppm. There was no available chlorine in RO water or distilled water (each from tap water). The reduction or disappearance of available chlorine appears to be associated with microbial contamination of UF water, RO water and distilled water.
Chlorine↗
Cytokine synthesis of human monocytes stimulated by triple or single helical conformer of an antitumour (1-->3)-beta-D-glucan preparation, sonifilan.
It has been suggested that the immunopharmacological activity of soluble (1-->3)-beta-D-glucan depends on it's conformation in mice. In this study, we examined the relationship between the conformation of Schizophyllan (SPG), a high molecular weight (1-->3)-beta-D-glucan, and cytokine productivity in an in vitro human system. Monocyte-like human cell lines, THP-1 and U-937, and peripheral blood mononuclear cells (PBMC) were used. THP-1 and U-937 cells were differentiated by phorbol myristate acetate (PMA) before use. SPG usually has a triple helical conformation in water, but it was modified by treatment with aqueous sodium hydroxide to become a single helical conformer (SPG-OH). SPG or SPG-OH was added to the macrophage cell culture and gene expression and translation of several cytokines was analyzed by RT-PCR, ELISA, or bioassays. Differentiated THP-1 expressed high levels of cytokine genes, such as IL-8, in response to SPG-OH. High levels of IL-12 p70 were detected from THP-1 cells stimulated with SPG-OH. U-937 cells expressed high levels of IL-8 and TNF-alpha after SPG-OH treatment. Furthermore, PBMC isolated from healthy donors also strongly reacted with SPG-OH but not with SPG. High concentrations of TNF-alpha were detected in SPG-OH-stimulated PBMC cultures. These data suggest that the biological activities of SPG are strongly associated with its conformation in humans.
Adjuvants, Immunologic↗
Minimally invasive cardiac surgery: current status and perspective.
Recently, the minimally invasive approach has become a growing aspect in the field of cardiac surgery with the goal of eliminating cardiopulmonary bypass (CPB) and/or median sternotomy. In coronary bypass surgery, the application of this approach is direct anastomosis, primarily of the left internal thoracic artery to the left descending coronary artery under a beating condition without the use of CPB through a small left thoracotomy minimally invasive direct coronary artery bypass (MIDCAB). In the repair of intracardiac lesions, CPB cannot be excluded, but a small right parasternal incision or small partial sternotomy (ministernotomy) has been applied for congenital defects and mitral and aortic valve lesions. With technological advances in CPB, these approaches may become more popular in the near future.
Anastomosis, Surgical↗